Justia Insurance Law Opinion SummariesArticles Posted in US Court of Appeals for the Seventh Circuit
Mathis v. Metropolitan Life Insurance Co
In 2006, Moore, an Indiana-based insurance broker, advised Mathis, an Alabama surgeon, to replace his Standard disability insurance policy with a MetLife disability-insurance policy with higher limits that had occupational disability coverage, like the Standard policy. The MetLife policy did not actually provide occupational disability coverage but provided total disability coverage only if Mathis was not gainfully employed and provided residual disability coverage only under various limitations. Mathis became disabled in 2017. Neck and arm problems prevented him from performing some of his duties. He underwent surgery but could no longer work at his usual level; his income decreased. He left his practice in March 2018 and began working for a device manufacturer in a nonsurgical capacity. MetLife paid Mathis residual disability benefits, April-August 2017, then determined he was not entitled to residual disability benefits. The policy lapsed.Mathis sued Moore and Source Brokerage for negligent procurement and brought a breach of contract claim against MetLife. The Seventh Circuit affirmed the dismissal of the claims, applying Alabama law, rather than Indiana law. Mathis’s contributory negligence in failing to read the new policy and the Alabama statute of limitations barred the negligence claims. The court rejected the contract claim because Mathis failed to comply with his contractual obligation to submit proof of loss for any period after September 2017. View "Mathis v. Metropolitan Life Insurance Co" on Justia Law
Netherlands Insurance Co. v. Macomb Community Unit School District
Two female students brought claims under Title IX, 20 U.S.C. 1681–88, alleging that the School District failed to prevent and inappropriately responded to sexual misconduct by a male student. The incidents occurred while the District did not have insurance coverage for sexual misconduct and molestation. After the District settled the suit for $1.5 million, its insurers sought a declaration of their rights and obligations under the District’s errors-and-omissions coverage. The district court held that the errors and omissions coverage applies although the policy contains a sexual misconduct exclusion. The judge stated that the exclusion was ambiguous and could be read to exclude only sexual misconduct by a school employee and might not bar coverage for “reactions to” a student’s sexual misconduct.The Seventh Circuit reversed. The sexual-misconduct exclusion is not ambiguous in precluding coverage for “[a]ny” sexual misconduct or molestation of “any person” and related allegations. Even if the sexual-misconduct exclusion barred only coverage for employees’ actions, the exclusion still applies. The District is not directly liable for misconduct by students. A school district can be liable for discrimination in cases of student-on-student sexual misconduct under Title IX only if the district has notice and is deliberately indifferent. By excluding coverage for “allegations relating” to sexual misconduct, the exclusion necessarily bars coverage for “reactions to” sexual misconduct. View "Netherlands Insurance Co. v. Macomb Community Unit School District" on Justia Law
United Fire & Casualty Co. v. Prate Roofing & Installations LLC
All Seasons inspected SparrowHawk's warehouse roofs and discovered hail damage. Because All Seasons did not hold an Illinois roofing license, it arranged for Prate to serve as general contractor with All Seasons as subcontractor. All Seasons was to provide materials and labor, maintain safety, and supervise the project. All Seasons purchased a commercial general liability policy and general liability extension endorsement from United, listing Prate as an “additional insured” in a “vicarious liability endorsement.” All Seasons then subcontracted with Century. Ayala, a Century employee was working on a SparrowHawk warehouse when he fell to his death.The Illinois workers’ compensation system provided limited death benefits but precluded tort remedies against his direct employer, Century. Ayala’s estate sued Prate, All Seasons, and SparrowHawk. Prate tendered the defense to United, which declined to defend and sought a declaratory judgment. All Seasons and United reached a settlement with the estate, paying the policy limits.The district court granted Prate summary judgment. The Seventh Circuit affirmed, rejecting United’s argument that because its named insured was an independent contractor, Illinois law would not impose any liability on the additional insured and there was no risk of covered liability. The duty to defend depends on the claims the plaintiff asserts, not on their prospects for success. The settlement of the underlying claims against the named insured, however, removed any possibility that the additional insured might be held vicariously liable for actions of the named insured; the duty to defend ended when that settlement was consummated. View "United Fire & Casualty Co. v. Prate Roofing & Installations LLC" on Justia Law
StarNet Insurance Co. v. Ruprecht
Deerfield. the general contractor, subcontracted with P.S. Demolition, which agreed to indemnify and hold Deerfield harmless from all claims caused in whole or in part by P.S. P.S. employees were working at the site when an unsecured capstone fell, killing one and injuring another. The Illinois Workers’ Compensation Act limited P.S.’s liability to $5,993.91 and $25,229.15. The state court held that P.S. had waived the Kotecki cap that would ordinarily apply those limits to a third party (Deerfield) suing for contribution for its pro-rata share of common liability for a workplace injury. A bankruptcy court determined that P.S. had no assets; the state court determined that P.S.’s liability was limited to its available insurance coverage. Deerfield settled with the plaintiffs for substantially more than $75,000 plus an assignment of Deerfield’s contribution claim against P.S.StarNet, P.S.’s employer liability insurer, entered into a settlement with the plaintiffs, reserving its defenses to insurance coverage. The plaintiffs dismissed their negligence claims against P.S. The workers’ compensation and employers' liability policy issued to P.S. provides that StarNet will pay damages for which P.S. is liable to indemnify third parties, excluding “liability assumed under a contract, including any agreement to waive your right to limit your liability for contribution to the amount of benefits payable under the Workers Compensation Act ... This exclusion does not apply to a warranty that your work will be done in a workmanlike manner.The Seventh Circuit affirmed a declaratory judgment that StarNet owes P.S. no coverage for the employees’ injuries beyond the amounts specified by the Illinois Workers’ Compensation Act and the Kotecki cap. The court rejected arguments that P.S.’s liability in the personal injury action arose in part from P.S.’s failure to conduct the demolition in a workmanlike manner so that the exception applies. View "StarNet Insurance Co. v. Ruprecht" on Justia Law
American Bankers Insurance Co v. Shockley
SFC, an equestrian center hosted off‐site trail‐riding events. SFC and American entered into a “farm-owner” insurance policy that described the insured premises as the farm’s address. The policy provides coverage for bodily injury and property damage caused by an “occurrence” that arises out of the ownership, maintenance, or use of the “insured premises” or operations that are necessary or incidental to the “insured premises.” There is no coverage for the use of a motorized vehicle except a “motorized vehicle” which is designed only for use off public roads and which is used to service the “insured premises.” Ratay, an SFC employee, transported horses, equipment, and a golf cart from the farm to a riding center approximately 15 miles from SFC’s property, and supervised those riding SFC horses while driving the SFC golf cart. Shockley was a passenger in the cart when Ratay chased a horse through a field. Shockley flew out of the vehicle. The cart ran over his leg. Shockley filed suit.The district court entered a declaratory judgment that American has no duty to defend or indemnify SFC. The Seventh Circuit reversed. In Illinois, the duty to defend is broader than the duty to indemnify. The court noted ambiguities caused by the policy’s competing characteristics as a farm-owner policy and as a commercial general liability policy. The complaint’s allegations sufficiently invoke the policy’s coverage; the golf cart was being used for business purposes. View "American Bankers Insurance Co v. Shockley" on Justia Law
Continental Western Insurance Co. v. Country Mutual Insurance Co.
In 1989, the Hamel Fire Protection District and Alhambra Fire Protection District formed a joint venture, “the Service” to provide ambulance service to residents of both districts. In 2012, a Service-operated ambulance collided with a semi-truck. The semi-truck drivers and ambulance passengers were seriously injured. The accident produced three lawsuits that eventually settled. Continental paid all attorney’s fees assessed for Hamel Fire’s defenses. Country Mutual had issued a multiperil commercial lines insurance policy to the Service.. Hamel Fire was the named insured on the Continental policy. Continental defended Hamel Fire in each lawsuit after first tendering them to Country Mutual, which ignored each tender. The ambulance was a covered auto under policies issued by both, which provided primary coverage for owned autos and excess coverage for non-owned autos.Continental sued Country Mutual. The district court granted Continental’s motion for summary judgment finding that the Service, and not Hamel Fire, owned the ambulance. Based on that finding, and both policies’ “Other Insurance” clauses, the court determined that Country Mutual owed primary coverage for the costs to defend Hamel Fire in the underlying lawsuits, while Continental only owed excess coverage. The Seventh Circuit affirmed, reasoning that the evidence strongly reflects the parties’ intent that Country Mutual’s insured owned the ambulance. The resulting award of attorney’s fees under Illinois law was reasonable. View "Continental Western Insurance Co. v. Country Mutual Insurance Co." on Justia Law
Christopherson v. American Strategic Insurance Co.
Two trees fell on Christopherson’s home, months apart, resulting in its total destruction. The village ordered demolition. Christopherson’s insurer, ASI, had advanced living expenses but did not provide the requested demolition payment by the village's deadline, so Christopherson razed the house himself. He did not provide invoices for the demolition or for his own labor. Christopherson sued, alleging bad-faith denial of policy benefits and informed ASI that, excluding personal property losses and additional living expenses yet to be determined, Christopherson’s losses were $143,384: the $135,000 dwelling coverage limit, $6,884 for demolition, and $1,500 for tree removal. ASI indicated that it would pay that amount, noting that it had not yet received any notice of claims for personal property.The court granted ASI a discovery protective order with respect to the bad faith claim, reasoning that Christopherson could not establish any underlying breach of the policies. ASI had already paid the full limits of his 2018–19 policy, Christopherson’s claims under his 2017–18 policy, and his additional living expenses under both policies. ASI obtained summary judgment. Christopherson had not presented evidence of costs actually incurred but not paid by ASI and could not show a breach; he had nearly exhausted the limits under both policies.The Seventh Circuit affirmed, rejecting an argument that the case should be remanded to state court. Christopherson’s arguments ignore policy provisions that the insured must first incur the expenses and then provide the insurer with documentation before the insurer is obliged to pay. View "Christopherson v. American Strategic Insurance Co." on Justia Law
Creation Supply, Inc. v. Selective Insurance Co. of the Southeast
This case involves a decade-long, three-lawsuit dispute between the insurer and the insured over who owed what when. At issue in this appeal is whether the district court properly awarded extracontractual damages to the insured under Section 155 of the Illinois Insurance Code. Section 155 permits an insured to seek extracontractual damages from an insurer in any case in which at least one of three issues remains undecided: (1) the insurer's liability under the policy, (2) the amount of the loss payable under the policy, or (3) whether there was an unreasonable delay in settling a claim.The Seventh Circuit concluded that the insured cannot pursue Section 155 damages in this action because none of these three threshold issues remains undecided. In this case, the insurer's liability under its policy with the insured was resolved by the Illinois Appellate Court in 2015; the amount of loss payable by the insurer to the insured under the policy was determined by the Illinois Appellate Court in 2017; and the insured does not seek recovery for any unreasonable delay by the insurer in settling the insured's claim. Therefore, none of the insured's extracontractual issues remain undecided. Accordingly, the court reversed the district court's decision granting relief to the insured under Section 155. View "Creation Supply, Inc. v. Selective Insurance Co. of the Southeast" on Justia Law
Mesa Laboratories, Inc. v. Federal Insurance Co.
Mesa sent faxes promoting its services. Some recipients had not consented to receive such faxes, and the faxed materials did not include an opt‐out notice as required by the Telephone Consumer Protection Act (TCPA), 47 U.S.C. 227(b)(1)(C). Orrington filed a class‐action lawsuit under the TCPA and the Illinois Consumer Fraud and Deceptive Business Practices Act and alleged that Mesa’s conduct constituted common‐law conversion, nuisance, and trespass to chattels for Mesa’s appropriation of the recipients’ fax equipment, paper, ink, and toner. Mesa notified its insurer, Federal, of the Orrington action. Federal declined to provide a defense. After Mesa and Orrington reached a settlement, Mesa sued Federal, alleging breach of contract, bad faith, and improper delay and denial of claims under Colorado statutes.The Seventh Circuit affirmed summary judgment in favor of Federal. The policy’s “Information Laws Exclusion” provides that the policy “does not apply to any damages, loss, cost or expense arising out of any actual or alleged or threatened violation of “ TCPA “or any similar regulatory or statutory law in any other jurisdiction.” The exclusion barred all of the claims because the common-law claims arose out of the same conduct underlying the statutory claims. View "Mesa Laboratories, Inc. v. Federal Insurance Co." on Justia Law
MAO-MSO Recovery II, LLC v. State Farm Mutual Automobile Ins. Co.
MAO-MSO acquired rights to collect conditional payments that Medicare Advantage Organizations (MAOs) made if a primary insurer (such as automobile insurance carriers) has not promptly paid medical expenses. MAO-MSO sued those primary payers. The district court proof of required actual injury. Specifically, MAO-MSO needed to identify an “illustrative beneficiary”— a concrete example of a conditional payment that State Farm, the relevant primary payer, failed to reimburse to the pertinent MAO. MAO-MSO alleged that “O.D.” suffered injuries in a car accident and that State Farm “failed to adequately pay or reimburse” the appropriate MAO. The district court determined that these allegations sufficed for pleading purposes to establish standing.As limited discovery progressed, MAO-MSO struggled to identify evidence supporting the complaint. One dispute centered on whether O.D.’s MAO made payments related to medical care stemming from a car accident before State Farm reached its limit under O.D.’s auto policy so that State Farm should have reimbursed the MAO. The payment in question was to a physical therapist. State Farm argued that the physical therapy services had no connection to O.D.’s car accident and related only to her prior knee surgery.The district court determined no reasonable jury could find that the payment related to O.D.’s car accident, meaning that MAO-MSO lacked standing. The Seventh Circuit affirmed the dismissal. The Medicare Act may authorize the lawsuit but MAO-MSO fail to establish subject matter jurisdiction by establishing an injury in fact. View "MAO-MSO Recovery II, LLC v. State Farm Mutual Automobile Ins. Co." on Justia Law